| NPI | 1255508487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 5101019112) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101019112) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2012-12-05 |